ENROLLMENT AND PARTICIPATION

Does my business have to provide Brooklyn HealthWorks coverage to all my employees?
Small businesses participating in the program must offer Brooklyn HealthWorks coverage to all eligible employees working more than 20 hours weekly and earning $38,000 or less annually.

Do all eligible employees have to obtain coverage through Brooklyn HealthWorks?
No. Of the eligible employees, at least 50% must obtain coverage through Brooklyn HealthWorks OR have coverage through another source, such as a spouse.

Can owners and managers of a company have coverage that is different from non-owners/non-managers?
Yes. Insurance regulation allows employers to offer different health plans to employees in distinct categories – as long as all eligible employees within a category are offered the same coverage.  This means that managers at a business may have coverage through HIP or Atlantis, for example, and non-managers may have coverage through Brooklyn HealthWorks.

Can individuals earning more than $38,000 per year obtain coverage through Brooklyn HealthWorks?
Yes, but at least one person making $38,000 or less must obtain coverage through Brooklyn HealthWorks.

How much does my business have to contribute towards Brooklyn HealthWorks coverage?
We leave that decision up to individual business owners, however, we encourage employers to contribute as much as possible towards monthly premiums and have found that most contribute 80% or more towards individual coverage.  Providing and paying for health benefits are proven ways to attract and retain the most qualified employees for your business.

Can my business offer Brooklyn HealthWorks coverage to my employees’ family members?
Yes. You may choose to offer coverage for dependents through Brooklyn HealthWorks. Qualifying dependents include spouses, domestic partners, and dependent children up to age 19 and full-time students up to age 25.

If my business offers Brooklyn HealthWorks coverage to employees’ family members, do I have to contribute towards the cost of the premiums?
No, but we encourage all businesses to contribute as much as possible towards employee premiums and coverage extended to family members.

When must I sign up dependents or new hires seeking coverage through Brooklyn HealthWorks?
Dependents seeking coverage must sign up within 30 days of becoming eligible for coverage or wait until the annual anniversary date of the policy.  For example, a spouse must enroll within 30 days of becoming married to a covered employee or within 30 days of losing health insurance coverage from his or her place of employment.  Similarly, a newborn must be signed up within 30 days of birth. 

New hires at a business must enroll within 30 days of becoming eligible for coverage.  When businesses sign up for Brooklyn HealthWorks coverage, they determine their new hire eligibility policy by completing this simple form.

Can my business offer coverage to seasonal workers and those working less than 20 hours per week?
Yes. If coverage is offered to these workers, you may include their wages when determining if your business qualifies for Brooklyn HealthWorks.

Can my business provide coverage for independent (1099) contractors?
Yes. You may provide coverage to independent contractors who are expected to work an excess of 1,144 hours for the business during the twelve months they have coverage through Brooklyn HealthWorks.  Businesses seeking to provide Brooklyn HealthWorks coverage for 1099 workers must also enroll their traditional W-2 workers in the plan.

Do you provide coverage for sole proprietors?
No. We currently do not enroll sole proprietors, but the health insurance specialist at the Brooklyn Chamber of Commerce can help sole proprietors identify affordable plan options.  Call 718-943-3882 for assistance.

When is the deadline to sign up for Brooklyn HealthWorks coverage?
A complete application with all supporting documentation must be received by 5 pm on the 15th of the month for coverage beginning the 1st of the following month.  For assistance with completing the application and determining what supporting documentation is required, please contact Theresa Reyes by calling 718-596-4550 or e-mailing her at treyes@brooklynchamber.com.

Does my business have to be a Member of the Brooklyn Chamber of Commerce to obtain coverage through Brooklyn HealthWorks?
No. Your business does not have to be a Member of the Brooklyn Chamber of Commerce.  There are advantages to Chamber membership, however, such as access to monthly networking events attracting hundreds of other businesses and promotional opportunities in the Chamber’s widely circulated newspaper and print and online Member directories.  If you submit a Brooklyn Chamber membership application with your Brooklyn HealthWorks enrollment forms, you will receive a one-time $100 discount off your Chamber membership.  Contact Ken Varga at kvarga@brooklynchamber.com or 718-943-3872 for additional information about Chamber membership and to take advantage of this special offer.

ONGOING ELIGIBILITY

Is there a re-certification process?
Yes. On an annual basis, employers with Brooklyn HealthWorks coverage are required to submit a simple re-certification form that attests to their continued eligibility for the program. We will notify you when this re-certification is due and will provide you with all the necessary forms.

What if my business qualifies for Brooklyn HealthWorks and things change?  For example, what if some of my employees drop coverage and my business no longer satisfies the 50% employee participation requirement? Would my coverage then be terminated?
Mid-year fluctuations in group size, wage levels and employee participation will not result in immediate termination of Brooklyn HealthWorks coverage. However, Brooklyn HealthWorks requires an annual re-certification process at which time your business’ eligibility will be reevaluated. If your business does not meet the eligibility criteria at the time of re-certification, you will be unable to continue to participate in the program.

BENEFITS AND PROVIDER NETWORK

What benefits are covered through Brooklyn HealthWorks?
Most medical and hospital services are included in Brooklyn HealthWorks coverage and prescription drugs are covered up to $3,000 per calendar year for each covered enrollee.  For a summary of benefits and associated co-payments and deductibles, click here.

Can I obtain dental and vision benefits through Brooklyn HealthWorks?
Depending on how many employees are enrolling, we will be able to assist you in finding an affordable dental and vision plan to add to your Brooklyn HealthWorks coverage.

Are pre-existing conditions covered through Brooklyn HealthWorks?
There is a twelve-month waiting period for benefits for any condition, disease or symptom for which medical treatment or advice was recommended or received within the six-month period prior to the enrollment date. There will be no coverage for pre-existing conditions during this waiting period. This waiting period will be reduced to the extent that you are entitled to a credit for coverage under a previous health plan and did not have a lapse in coverage of 63 days or more.

Will my doctor accept Brooklyn HealthWorks coverage? 
Most doctors in the New York City area accept Brooklyn HealthWorks coverage. To determine if your doctor will accept Brooklyn HealthWorks coverage, you can ask him or her directly or go to GHI’s Website and enter “Healthy New York EPO” as the plan.

Which provider network does Brooklyn HealthWorks use?
Brooklyn HealthWorks Subscribers benefit from in-network access to GHI's Tri-State network, with more than 142,000 participating provider locations, the majority of the "Top Docs" listed in New York Magazine, and virtually every acute care hospital in New York State.

What happens if I go out of network to see a doctor?
With the exception of medical emergencies, all claims submitted from a provider not participating in GHI’s Tri-State network will not be covered, and the individual Subscriber will be responsible to pay 100% of the claim.

Do I need a referral to see a specialist?
No. You do not need a referral to see a specialist as long as you see a GHI provider in the Tri-State network.  We do, however, strongly advise that you develop a relationship with a primary care physician who can help you maximize your medical benefits and reduce the chances of going out of network.

CUSTOMER SERVICE AND BROKERS

After I’m enrolled with Brooklyn HealthWorks, who do I contact to add or drop an employee from coverage?
All changes to your policy should be made through Brooklyn HealthWorks – not GHI.  We will work with GHI to make sure all changes are made in a timely manner.  With the exception of medical claims, generally your first point of contact about your plan should be the Brooklyn HealthWorks staff that may be reached by calling 718-596-4550.  You may also e-mail Theresa Reyes at treyes@brooklynchamber.com with any questions you have about Brooklyn HealthWorks.

Who do I contact about medical claims?
GHI processes all medical claims for Brooklyn HealthWorks.  You should begin by contacting GHI to clarify any issues involving medical claims.  If you still have questions about a specific medical claim, please contact our office at 718-596-4550 for assistance.

Why does Brooklyn HealthWorks use insurance brokers?
Brooklyn HealthWorks has a small staff and cannot meet with all businesses at their place of work.  We rely on brokers to personally help you with the enrollment process and assist you with other matters that may arise throughout the year.

Do I have to use a Brooklyn HealthWorks broker or may I continue to use my own broker? 
You may use any licensed insurance broker with the New York State Department of Insurance.  Brokers selling Brooklyn HealthWorks must have a signed selling agent agreement and selling agent appointment through our insurance carrier, GHI.

How much does it cost to have a broker help me with the enrollment process?
A broker commission is built into most small business health insurance plans, including Brooklyn HealthWorks.  You pay the same monthly amount regardless of whether a broker assists you or not.

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